The Importance of Exercise for Aging WomenFor women over 50, it’s “move it or lose it,” says women's health expert Dr. Kirtly Parker Jones. Weak bones from osteoporosis or creaky joints from arthritis are more likely…
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August 27, 2020
Bone Health
Womens Health Your arthritic joints ache, and there's a soft chair and a great book that's calling you. Tomorrow, you'll get a little exercise. Really? After 50, it's use it or lose it. That refers to your brain, your bones, your joints, your muscles, and your heart. And after 50, the best perspective is move it or lose it. Although many of the studies on aging and exercise use men as research subjects, more and more are including older women, and some specifically focus on women. Women are more likely to develop fragile bones from osteoporosis and creaky joints from osteoarthritis, and both are significantly improved with exercise. Women are more likely to be diagnosed with depression and anxiety, which may be like asking for directions. They are more likely to ask for help with these conditions than men, so are given the diagnosis more often. The most common, crippling diseases of aging that lead to loss of life and quality of life include diabetes, hypertension, heart failure, and dementia. All can be modified for the better with exercise. Now, not all exercise does the same thing, and the same kind of exercise can be boring. Some exercises are off the table because of joint pain. Running is less likely to be comfortable with knee arthritis even though there's evidence that moving those joints makes them better. Some exercises are easy on your knees, but you have to get into a swimsuit, you know, hat black piece of Lycra that's hiding somewhere that you haven't put on for some years. The good news is that Lycra in old swimsuits seems to be infinitely stretchable, and at the pool, in the water aerobics class, it's just a giggle. You're under the water. Nobody can be looking at you, and you can look at everybody walking by. What fun. For women in midlife, the following types of exercise are important. They don't need to be done every day and they don't take a long time, but some mix needs to be getting into your exercise salad. Cardio. Ugg, I hate it when my heart beats fast. I spent a professional life as an OB-GYN working to stay calm and keep my heart rate down. But I know that getting my heart rate up is good for my brain and my heart. Let's start with the brain. Randomized trials have found that short bouts of high-intensity exercise, 5 to 10 minutes, increases your capacity to do cognitively challenging tasks that require what's called executive function, to hold one thing in your brain that helps you solve the next step. That's really important in living. Being cardiovascularly fit, being able to do and doing cardio decreases your risk of developing dementia. It also improves insulin function, which decreases your risk of diabetes. There are lots of videos about short, high-intensity workouts, HIIT, high-intensity interval training. You don't want to run in public? How about stairs? Six minutes of going upstairs as fast as you can. Can only do it for a minute? Can only do it for 30 seconds? Work up to it. You don't have any stairs? Get a little step, 6 to 10 inches. Up one foot, then down. Up on the other foot, then down as fast as you can for a few minutes. It's okay to hold on to a chair if you're worried about your balance. Swimming, biking, rowing, running, hiking uphill, or any exercise that get your heart rate up is the right thing. Make your heart work a little is good for your heart. Strength training. Now, post-menopausal women can put on muscle, and muscle improves insulin function. Being strong means that you can get out of a chair. Being strong means that you can rebalance yourself if you get tippy. Weight-bearing exercise in mice builds new memory neurons. Now, remember, mice like to run. They don't like to lift weights. So maybe it was the stressful new thing that was making them build new memory neurons. This probably works for women too. Or it works to improve cognitive function because new exercises, novel physical activities build more brain connections. You can do this at home. There are videos of six-minute workouts. Developed by The New York Times is a good one, that works all your muscle groups and there are bunch of them available. Stretching and flexibility. Of course, yoga is the poster child for stretching and flexibility, but yoga was developed in a country where people have been squatting since birth, and they're more flexible. Still there are a lot of videos about stretching and keeping a range of motion in your neck, your shoulders, your hips, your knees, and your feet. Balance. Tai Chi is the poster child for senior citizens doing balance, but there are balance exercises that you can do at home while you're brushing your teeth or waiting for the water to boil while you're making coffee. And you can Goggle "balance exercise for seniors" on your YouTube. You aren't senior? Okay, you can check out balance for deniers. There's any age. I'm a fan of Bob and Brad, the most famous physiotherapists on the internet, in their opinion, and they have lots of balance exercises. How much? The American Heart Association recommends 150 minutes a week of moderate exercise, a brisk walk, or 75 minutes a week of vigorous exercise. And that's only about 10 and a half minutes a day if you're doing it vigorously or a combination of both. Recommendations for midlife women for resistance training, read weights, are 20 minutes 2 to 3 times a week. The 20 minutes could be several sessions of the 6-minute workout. Put the phone down. Put the book down. Walk away from the computer. Ten minutes, three times a day, upstairs, some weights, some balance. Mix it up. Pushing and pulling and lifting in the garden counts as resistance training. Ten minutes, only 10 minutes, your heart, your brain, your joints, your mood, your sleep will all get better. Then do it again. And thanks for joining us on The Scope.
Weak bones from osteoporosis or creaky joints from arthritis are more likely to develop with age. The best way to prevent these conditions is exercise. |
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Women's Health: Keeping Your Bones Strong as You AgeOlder women are particularly vulnerable to fragility fractures as their bones thin with age. Recent studies show touted vitamin supplements don't actually work. Women's health expert Dr.…
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May 28, 2020
Bone Health
Womens Health All of us who have had a friend or a family member who's suffered a broken hip from thin bones worry about how to protect our own bones. A fragility fracture is a broken bone that occurs from forces that wouldn't have caused a fracture in bones that are normally strong. We think of them as broken bones, usually in the hip, the top of the thigh bone that attaches to the pelvic bone, the wrist, or fractures in the vertebral column that make the building blocks of the vertebrae scrunch a little flatter, causing curvature of the spine. "Scrunch" isn't a word that bone experts would use, but it sort of fits. Populations That Are Susceptible to Fragility FracturesSo bones get thinner and are less strong as we age, and women have thinner bones than men. White and Asian women have thinner bones than African women. One in three white women and one in five white men will have a fragility fracture in their lifetime. For elderly men and women, about one half who suffer a fragility fracture of the hip will no longer be able to live independently. So this is a big medical and social problem costing billions of dollars each year in medical and assisted living expenses and the social costs of loss of independence. Now, there's a lot of heat but not much light on what we, as middle age women, can do to keep our bones strong. So things we can't change, we can't change our genetics, that includes our sex. Women have thinner bones at peak bone density than men. Our race, African women have denser bones than white women. And we can't change our genetic risk for osteoporosis. Some are just born with thinner bones. We can't change our medical history. Some of us have diseases such as asthma or rheumatoid arthritis or other diseases that are treated with corticosteroids, which are drugs that work miracles for some diseases, but cause bone thinning. Luckily, these days there are increasingly alternatives to steroids, and there are other medications that cause thin bones. Bone Strengthening BehaviorWe can change our behavior. If we are young, we should try to reach our peak bone density, which comes in our mid-30s, with the strongest bones that our nature will give us. That means that when we went through childhood and early adulthood being active, eating a balanced diet with adequate calcium, and getting outside to get our vitamin D. Now, I'm not sure what the future holds for a generation of kids who grew up inside, in front of video screens. If we are smokers, we should have stopped a long time ago. Smoking makes for thin bones, but it's only one of the many more diseases, more deadly than thin bones that's caused by smoking. Drinking alcohol in excess also causes thin bones, and it makes people fall down. So if we are in midlife, poorly defined, but I picked 45 to 65, and we cannot make our bones much stronger, and we do want to keep our bones from getting thinner, what works? Well, there's a lot of disagreement among health professionals about what works and what doesn't work to keep bones denser. And while we measure it, part of how we measure it is the problem. We can measure bones' density but that doesn't always equate to bone strength. Some dense bones are brittle and break. We don't have a good measurement of bone strength. Many studies of treatments to prevent osteoporosis fractures look at bone density as an endpoint, but what we really want to know is does this intervention decrease fractures? So what doesn't work? Calcium supplements for women eating a standard American diet does not increase the risk of fractures. This has been shown in large randomized trials that were part of the Women's Health Initiative, a huge study on what works and doesn't work for women's health as they get older. That doesn't mean you don't need calcium, you just need a balanced diet. Vitamin D supplements don't work. An analysis of 23 studies that were randomized, and randomized middle aged people to varying amounts of vitamin D showed no difference in bone density in those taking vitamin D compared to placebo. Even when Vitamin D is suggested, the amount suggested varies. The American suggest 800 to 1,000 international units of vitamin D per day for middle aged people, and the British recommend 400. That doesn't mean that people who are truly vitamin D deficient, as measured by vitamin D levels, shouldn't take supplements. But people who are, are home-bound and never see the sun will be vitamin D deficient, but they're also at risk for fragility fractures because they're sick and frail with respect to their muscles and their balance. Exercise doesn't work to change bones' density much. We recommend weight bearing exercise because we know astronauts and bedridden people lose bone density, but for the average person, exercising just to build bone density doesn't make a big difference. Now, that doesn't mean the exercise doesn't decrease bone fractures. It could be that people who cannot exercise have more fragile bones because they don't move at all, or they don't eat or they drink too much alcohol or they have one of the many factors that make them frail and more likely to have a fragility fracture. But for people who can exercise, adding more to increase bone density doesn't make a difference in bone density. Exercise for Bone StrengthWe do know that people who exercise have fewer fractures. Maybe exercise makes stronger bones, bones that are more resilient, and maybe, most importantly, exercise makes us less likely to fall. This has been shown in small randomized trials of tai chi and yoga, both of which have a lot of balance work. The British National Health Service actually recommends getting outside in the sun. The sun never shines in Britain, of course. The Americans don't recommend that so strongly, but getting out means also moving a little, both of which are good. Testing and Treatment to Slow Bone ThinningSo what should we do? We should know our own medical history. And if we have risk factors of prolonged immobility, corticosteroid use, or other factors, we should get our bone density measured earlier than 65 years of age. The recommendation from the Preventative Services Task Force recommends bone density testing at 65 for the average woman without other risk factors. If you already have osteoporosis, there are medications that can slow bone thinning, and some can increase bone density, and some have been shown to decrease fracture risk. We should stop smoking, limit drinking to no more than one drink a day, get out and move every day, and exercises that include balance will decrease the risk of a fall. We should eat a balanced diet. We should talk to our health care providers about medications that we take that may increase the risk of bone thinning, like corticosteroids, or falling, like sleeping pills and some anti-anxiety medications. We should know if there's something about our health, diet, or habits that make us at risk for thin bones or falls, and intervene to make it better. Of course, if you want to add a calcium supplement or a vitamin D supplement in small doses, it most likely won't hurt anything but your budget, and you can save by not buying that extra bottle of wine.
Recommendations for keeping women's bones dense and strong. |
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Keeping Your Bones Healthy and Strong Through the YearsOsteoporosis and other bone conditions can mean the difference between living independently and needing full-time assistance as we age. Women's health expert, Kirtly Jones, MD, weighs in on what…
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April 07, 2023
Womens Health Get those bones as healthy as you can when you're young and they'll carry you the rest of your life. Learn about bone health, what you can do, what to avoid and why it matters and the biggest threat to bone health in women. This is Dr. Kirtly Jones from the department of Obstetrics and Gynecology at University of Utah Health Care and this is The Scope. We are living longer and moving less, we all worry about whether our brains will go the distance, will we be able to speak for ourselves at the end? But, in fact, our bones may fail before our brains do. The lifetime risk of a bone fracture, hip, wrist, spine, for a woman over 60 is almost 50%. Women in their 70s, 80s and in their 90s who have a hip fracture, it is the number one cause for the need to be moved to a nursing home. And if a woman in her 80s or 90s fractures a hip, she has a 50% chance of dying in the next year. So it turns out things you can make a difference is, your activity, your alcohol use, your smoking and whether you are eating and making your bones as strong as they should be by the time your in your 30s. Our peak bone density is in our 30s. Bones remain strong through good nutrition, sunlight or vitamin D and exercise. Women should eat right, maintain a healthy weight, avoid sodas, exercise a lot and get out in the sun or take vitamin D. This is what you should do before you're 30 to make sure your bones reach their peak bone density. If you get to 30 with puny bones, you will really have puny bones by the time you're 70. It's not going to get any better after 30. So after our 30s, we should eat right, maintain a healthy weight and keep moving. People who drink, people who smoke lose bone density faster and people who don't move don't keep their bones strong. After menopause, because here's where the real risk for fractures start to happen. Eat right, so you need calcium and vitamin D in your diet, get outside, but if you're not eating well or not getting in the sun because your dermatologist, who won the sun war, tells you not to, you can get vitamin D. Estrogens protect your bone density if you're taking estrogens, but after menopause your estrogens go down and you lose bone density. So stressing your bones keeps them stronger, cross train, jump, lift, work in your garden. Just walking is weight bearing exercise but you need to bend your bones a little bit, not so they'll break, but so that they'll get stronger. Balance training, keep your balance because after menopause women lose their sense of balance, so Tai-chi, yoga. If you're of normal risk, after 65 you should know your bone density and see if you need bone health. If you're at high risk, you're a smoker, a drinker, have had a fracture already or a family history of a fracture, or if you take some of those medications that make your bones thinner, then get your bone density checked earlier, talk with your doctor. To all of you, get out of your chair, I'm getting out of my chair right now, and keep moving. This is Dr. Kirtly Jones, thank you for joining us on The Scope.
Osteoporosis and other bone conditions can mean the difference between living independently and needing full-time assistance as we age. Learn what constitutes good bone health—and how you can help ensure your bones stay strong as you age. |